ED Coding & Reimbursement Alert - 2013 Issue 23
Enrollment: Review 3 FAQs to Ensure You Know When a New Provider Should Start Seeing Patients
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Article Overview
This article covers practical enrollment and credentialing guidance for practices bringing a new provider on board. It addresses when billing may begin, how payer policies can differ, and why timing matters for Medicare, private payers, and temporary coverage arrangements. The piece is aimed at practice managers, billing staff, and credentialing teams who need a broad understanding of enrollment workflow and related compliance risks.
Why This Topic Matters
Credentialing delays can affect when services may be billed, whether claims are payable, and whether a practice faces avoidable denials or compliance problems. Understanding the general enrollment process helps practices plan provider start dates and billing workflows more effectively.
Article Sections
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Can We Bill Retroactively?
This section discusses retroactive billing timing, differences between Medicare and private payer policies, and the importance of application timing in the enrollment process.
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Can We Just Use Another Provider’s NPI?
This section addresses billing under another provider’s identifier while credentialing is pending and discusses temporary coverage concepts referenced by the article.
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What is the Best Way to Ensure We Get Paid?
This section focuses on planning ahead for credentialing, starting enrollment early, and coordinating provider start dates with payer approval timelines.
What You Will Learn
- How provider enrollment timing can affect when billing may begin
- How Medicare and private payer credentialing workflows may differ in general
- Why practices should plan provider start dates around credentialing completion
- What broad compliance and payment risks can arise when enrollment is not complete
- How temporary coverage concepts are discussed in relation to enrollment timing
Who Should Read This
- Practice managers
- Medical billing staff
- Credentialing specialists
- Physician office administrators
- Revenue cycle teams
Modifiers Discussed
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